» Articles » PMID: 20200382

Comparison of Dopamine and Norepinephrine in the Treatment of Shock

Overview
Journal N Engl J Med
Specialty General Medicine
Date 2010 Mar 5
PMID 20200382
Citations 477
Authors
Affiliations
Soon will be listed here.
Abstract

Background: Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.

Methods: In this multicenter, randomized trial, we assigned patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. When blood pressure could not be maintained with a dose of 20 microg per kilogram of body weight per minute for dopamine or a dose of 0.19 microg per kilogram per minute for norepinephrine, open-label norepinephrine, epinephrine, or vasopressin could be added. The primary outcome was the rate of death at 28 days after randomization; secondary end points included the number of days without need for organ support and the occurrence of adverse events.

Results: The trial included 1679 patients, of whom 858 were assigned to dopamine and 821 to norepinephrine. The baseline characteristics of the groups were similar. There was no significant between-group difference in the rate of death at 28 days (52.5% in the dopamine group and 48.5% in the norepinephrine group; odds ratio with dopamine, 1.17; 95% confidence interval, 0.97 to 1.42; P=0.10). However, there were more arrhythmic events among the patients treated with dopamine than among those treated with norepinephrine (207 events [24.1%] vs. 102 events [12.4%], P<0.001). A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock (P=0.03 for cardiogenic shock, P=0.19 for septic shock, and P=0.84 for hypovolemic shock, in Kaplan-Meier analyses).

Conclusions: Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treated with norepinephrine, the use of dopamine was associated with a greater number of adverse events. (ClinicalTrials.gov number, NCT00314704.)

Citing Articles

Identifying Exifone as a Dual-Target Agent Targeting Both SARS-CoV-2 3CL Protease and the ACE2/S-RBD Interaction Among Clinical Polyphenolic Compounds.

Lu J, Tang Y, Li H, Chen X, Qin P, Xu J Int J Mol Sci. 2025; 26(5).

PMID: 40076865 PMC: 11900932. DOI: 10.3390/ijms26052243.


Acute Heart Failure and Non-Ischemic Cardiomyopathies: A Comprehensive Review and Critical Appraisal.

Manzi L, Buongiorno F, Narciso V, Florimonte D, Forzano I, Castiello D Diagnostics (Basel). 2025; 15(5).

PMID: 40075788 PMC: 11899404. DOI: 10.3390/diagnostics15050540.


The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024.

Shime N, Nakada T, Yatabe T, Yamakawa K, Aoki Y, Inoue S Acute Med Surg. 2025; 12(1):e70037.

PMID: 39996161 PMC: 11848044. DOI: 10.1002/ams2.70037.


Assessing the clinical impact of cardiac intensivists in cardiac intensivecare units: results from the RESCUE registry.

Bae D, Lee S, Bae J, Yang J, Ko Y, Ahn C BMC Cardiovasc Disord. 2025; 25(1):124.

PMID: 39984837 PMC: 11843748. DOI: 10.1186/s12872-025-04559-1.


An index of the initial blood pressure response to angiotensin II treatment and its association with clinical outcomes in vasodilatory shock.

Leisman D, Wieruszewski P, Busse L, Chawla L, Hibbert K, Handisides D Crit Care. 2025; 29(1):81.

PMID: 39972379 PMC: 11837372. DOI: 10.1186/s13054-025-05311-z.